Because no single modality can be used to address all areas effectively and safely, consensus guidelines on facial rejuvenation have been developed that discuss combined techniques for different parts of the face, namely, the upper, mid- and lower facial thirds. Most guidelines have also provided specific approaches for subjects of various ethnicities.[2,4,5] It is common to see the use of different combinations of injections (e.g., fillers, toxins) or energy devices (e.g., ultrasound) along with other modalities. The aim of using these techniques is to relax, resurface, and volumize facial tissue, and ultimately, to achieve the most harmonious and most natural-looking facial rejuvenation possible.[2] Hyaluronic acid (HA) fillers have now become the most common filler of choice due to their versatility, ease of use, and because they are well tolerated by most patients.[6]
Although botulinum toxin is often believed to be the mainstay of wrinkle correction, it is not recommended for all types of wrinkles. Specifically, it is only useful for the correction of dynamic wrinkles such as forehead lines, glabellar lines, periorbital lines (canthal), wrinkles seen on the dorsum of the nose, and fine lines around the lips. Because the effect of botulinum toxin is relatively poor for furrows, such as the deep nasolabial folds and marionette lines, fillers are mainly used to improve the appearance of these grooves. Botulinum toxin is also not recommended in some dynamic wrinkles such as the transverse infraorbital wrinkles and zygomatic wrinkles due to the risk of worsening the aesthetic appearance of the area [Figure 1].[19]
Clinical Anatomy Of The Face For Filler And Botulinum Toxin Injection Free Download
Download File 🔥 https://urllie.com/2yg5L6 🔥
The first signs of face aging appear in the midface, so procedures such as botulinum toxin and filler injections are performed there. However, no guidelines based on clinical anatomy describing the muscular and vascular components in vivo have been published. The aim of this research was to describe the depths of the midface muscles and the locations of vessels using ultrasonographic (US) imaging. US was applied at 12 landmarks on the midface in 88 volunteers (49 males and 39 females; 19-36 years) to detect sex differences in the depths of muscles and the locations of the vessels. The depths of the orbicularis oculi (OOc), levator labii superioris alaeque nasi (LLSAN), and zygomaticus minor (Zmi) differed significantly with sex at P7 (p = 0.001) and P8 (p = 0.017), P1 (p = 0.028), and P4 (p = 0.035), respectively. The facial artery, facial vein, angular artery, angular vein, and perforator vessels were found at P9, P2 and P10, P1, P1 and P5, and P8, P11 and P12, respectively. The findings indicate that the depths of the OOc, LLSAN, and Zmi muscles differ between the sexes and that the vessels appear at specific landmarks. This information could help in developing anatomical guidelines for several procedures.
Botulinum toxin injection for treatment of facial wrinkles is the most frequently performed cosmetic procedure in the United States, and it is one of the most common entry procedures for clinicians seeking to incorporate aesthetic treatments into their practice. Treatment of frown lines and crow's feet, which are the cosmetic indications approved by the U.S. Food and Drug Administration, and horizontal forehead lines, offers predictable results, has few adverse effects, and is associated with high patient satisfaction. Wrinkles are formed by dermal atrophy and repetitive contraction of underlying facial musculature. Botulinum toxin is a potent neurotoxin that inhibits release of acetylcholine at the neuromuscular junction. Injection of small quantities of botulinum toxin into specific overactive muscles causes localized muscle relaxation that smooths the overlying skin and reduces wrinkles. Botulinum toxin effects take about two weeks to fully develop and last three to four months. Dynamic wrinkles, seen during muscle contraction, yield more dramatic results than static wrinkles, which are visible at rest. Botulinum toxin injection is contraindicated in persons with keloidal scarring, neuromuscular disorders (e.g., myasthenia gravis), allergies to constituents of botulinum toxin products, and body dysmorphic disorder. Minor bruising can occur with botulinum toxin injection. Temporary blepharoptosis and eyebrow ptosis are rare complications that are technique-dependent; incidence declines as injector skill improves.
Botulinum toxin injection for treatment of facial wrinkles is the most frequently performed cosmetic procedure in the United States,1 and it is one of the most common entry procedures for clinicians seeking to incorporate aesthetic treatments into their practice.2 Botulinum toxin injection, particularly in the upper one-third of the face, offers predictable results,3 has few adverse effects,4 and is associated with high patient satisfaction.5 This article reviews relevant facial anatomy, patient selection, complications, and injection technique for cosmetic botulinum toxin treatment with a focus on frown lines. It is, however, not intended as a replacement for a formal instructional course.
Botulinum toxin is a potent neurotoxin protein derived from the Clostridium botulinum bacterium. It exerts its effect at the neuromuscular junction by inhibiting the release of acetylcholine, which causes temporary chemical denervation. At the cellular level, botulinum toxin functions by cleaving a docking protein (synaptosomal-associated protein of 25 kDA [SNAP-25]) on the internal surface of neuronal membranes, thereby inhibiting vesicle fusion and release of acetylcholine.7 Botulinum toxin effects in the targeted muscles diminish over time as SNAP-25 regenerates, and neuromuscular signaling and muscle contractility are restored.
The C. botulinum bacterium produces eight serotypes of botulinum toxin protein (A, B, C, C, D, E, F, and G). Botulinum toxin serotype A is the most potent and is used for cosmetic treatments. Botulinum toxin serotype B is used for medical conditions such as dystonia. There are currently three botulinum toxin serotype A products approved by the FDA for cosmetic use to treat glabellar complex muscles that form frown lines: onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), and incobotulinumtoxinA (Xeomin), which are summarized in Table 2.19,20 All three serotype A products have a 150 kDa core botulinum toxin protein and differ in whether they have complexing proteins surrounding the core neurotoxin. OnabotulinumtoxinA and abobotulinumtoxinA have hemagglutinin complexing proteins, whereas incobotulinumtoxinA is free from complexing proteins.19,21 Lack of complexing proteins may reduce antigenicity and hence antibody formation against botulinum toxin, but the clinical significance of complexing proteins has yet to be determined. Botulinum toxin products are not interchangeable because they vary in their formulation, dosing, and clinical response.
The targeted glabellar complex muscles can be identified by having the patient actively frown, and injections are placed into the contracted muscles (Figure 615 ). Small volumes of botulinum toxin solution are injected, typically 1 mL or less, using a 30-gauge, 1-inch needle. There are five injection sites, one injection in the procerus muscle and two in each of the corrugator supercilii muscles.15,20,24 Botulinum toxin is commonly used to treat other lines in the upper one-third of the face, such as horizontal forehead lines with injection in the frontalis muscle, and crow's feet with injection in the lateral orbicularis oculi muscles.10,11,25 Localized burning or stinging sensation during injection is commonly reported and resolves within a few minutes.15,17
Partial reduction in function of the targeted glabellar complex muscles is seen by the third day after botulinum toxin injection, with maximal reduction visible two weeks after injection.27 Figure 7 shows reduction of dynamic frown lines one month after treatment of the glabellar complex muscles with 20 units of onabotulinumtoxinA.15 Return of muscle function is gradual, typically three to four months after treatment. Subsequent treatment is advised when muscle contraction is visible in the treatment area before facial lines return to their pretreatment appearance.28 After multiple treatments, botulinum toxin effects may be prolonged and, for some patients, treatment intervals can be extended beyond three to four months.29
Complications related to botulinum toxin effects occur less frequently than injection reactions, and are primarily caused by temporary denervation of adjacent muscles outside of the intended treatment area. These complications are technique-dependent; incidence declines as injector skill improves.30,31 Temporary blepharoptosis (upper eyelid droop) is uncommon (1% to 5%) but is distressing for patients.9 It is almost always unilateral, seen as a 2- to 3-mm lowering of the affected eyelid that is most marked at the end of the day with muscle fatigue (Figure 815 ). Blepharoptosis is caused by deep migration of botulinum toxin through the orbital septum fascia to the levator palpebrae superioris, an upper eyelid levator muscle. Incidence of blepharoptosis is reduced by placing botulinum toxin injections at least 1 cm above the supraorbital ridge at the midpupillary line when treating the corrugator muscles.14,17 Blepharoptosis may be treated using ophthalmic solutions that have alpha-adrenergic effects, such as over-the-counter naphazoline 0.025%/pheniramine 0.3% or prescription apraclonidine 0.5% (Iopidine). Both medications cause contraction of Mller muscle, an adrenergic levator muscle of the upper eyelid, resulting in elevation of the upper eyelid. Apraclonidine is reserved for refractory cases and should be used with caution because it can exacerbate or unmask underlying glaucoma.32 Eyebrow ptosis and undesired eyebrow shape are usually related to unintended botulinum toxin effects in the frontalis muscle. Some of these complications can be corrected with botulinum toxin injection in muscles that antagonize the affected muscles; however, complications caused by involvement of adjacent muscles are temporary and will spontaneously resolve as botulinum toxin effects diminish. Facial asymmetry can result from uneven dosing of botulinum toxin. Consistent technique and careful attention to injection volumes at the time of treatment can reduce the incidence of asymmetries. 589ccfa754
Bhool Bhulaiyaa Movie Kickass Torrent Download